Utilization Review Specialist

Overview

UR Specialist

M-F

am- 4pm

Triangle Springs, part of Lifepoint Behavioral Health, nationally known healthcare organization with diversified delivery network with facilities from coast to coast, seeks passionate, patient-centric, and goal-oriented team members to join our team. We specialize in compassionate behavioral health services, including crisis stabilization, inpatient care, and outpatient treatment for acute mental health and substance use treatment. Our philosophy is built on a psychosocial model of care to decrease suicide rates, decrease addiction-related deaths, reverse the decline in life expectancy, and improve productivity in the communities we serve. We offer a collaborative work environment, competitive compensation, and flexible scheduling so you can focus on what matters–providing quality patient care. Join our team in Raleigh, North Carolina, to build a career that touches lives.

Position Details

• Acts as a liaison between managed care organizations and the facility’s behavioral health clinical treatment team.
• Conducts clinical reviews in accordance with certification requirements of insurance plans or other managed care organizations.
• Monitors patient length of stay and conducts initial and concurrent reviews when indicated to provide clinical information needed to support medical necessity criteria for appropriate level of care.
• Facilitates peer to peer reviews between the facility treatment provider and the managed care physician.
• Assists the Assessment Department with completion of the precertification process for admissions.
• Provides ongoing support and training for staff on documentation requirements, admission and continued stay criteria, and medical necessity updates.

Qualifications

Qualifications:

• Knowledge of mental health and chemical dependency terminology, symptoms, diagnoses, and treatment.
• Ability to communicate effectively with patients, internal and external treatment providers, and managed care clinical review care managers.
• Ability to multi-task, pay attention to detail, problem solve, utilize critical thinking skills, prioritize, and work both independently and as a part of a team.
• Strong computer skills and ability to navigate electronic systems applicable to job functions.

Requirements:

• Bachelor’s degree or current clinical license required in lieu of degree
• CPR and CPI Certification within days of employment

Experience:

• Previous utilization review experience in a psychiatric healthcare facility preferred
  Education and experience in the field(s) of: Social Work, Psychology, Psychiatric Nursing, Marriage and Family and Child Counseling, Chemical Dependency Counseling, Registered Nursing or a closely related science field